Provider Demographics
NPI:1831840081
Name:PACIFIC HIGHWAY DENTAL INC
Entity type:Organization
Organization Name:PACIFIC HIGHWAY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JHUTY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-954-9905
Mailing Address - Street 1:27020 PACIFIC HWY S STE C
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-6951
Mailing Address - Country:US
Mailing Address - Phone:253-529-9434
Mailing Address - Fax:253-529-1286
Practice Address - Street 1:27020 PACIFIC HWY S STE C
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-6951
Practice Address - Country:US
Practice Address - Phone:253-529-9434
Practice Address - Fax:253-529-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty